2017 Wicomico County Soccer – Fall
Individual Player Contract
PARTICIPANT INFORMATION
Full Name: __________________________________________________________ Gender: __________ Shirt Size: ___________
Birth Date: ________________ Age: _________School or Daycare: __________________________________________________
Parent/Guardian Name: _____________________________________________________________________________________
Phone #: _____________________________________ Email: ______________________________________________________
Address: _____________________________________________ City ______________________ St ________ Zip ____________
PROGRAM INFORMATION – Select your league based on your child’s birth year.
 U4 (2014 only)
 U6 (2013 & 2012)  U8 (2011 & 2010)
Wicomico Soccer League:  U10 (2009 & 2008)  U12 (2007 & 2006)  U14 (2005 & 2004)
FUNdamental Soccer:
Request coach to play for: ___________________________________________________________________________________
Request peer to play with: ___________________________________________________________________________________
Select your preferred field for home games: (U10, U12 & U14 only – U4, U6 & U8 play at Winterplace)
Winterplace (Salisbury)
ESYSC (Willards)
Hebron Park (Hebron)
Mason Dixon (Delmar)
Cedar Hill (Bivalve)
Gene Lowe (Sharptown)
PAYMENT INFORMATION, MEDICAL INFORMATION & WAIVER
Payment Amount:
$50 $5 Late Fee after July 28
Payment Type:
Cash Check Credit Card (MC or Visa)
Credit Card #:________________________________________________ Exp:___________ Verification Code (3 digit) ________
Signature______________________________________________________________________________________________
MEDICAL INFORMATION Please list clearly any medical conditions or medications taken that would affect participant’s involvement in this program:
_______________________________________________________________________________________________________________________________
May the Program Director call to discuss this accommodation? Yes___ No ___ May the coach be informed of the above listed conditions? Yes___ No___
CONCUSSION WAIVER
In compliance with Maryland HB 858 and SB 771, I hereby acknowledge that I have received the information regarding concussions published by
the United States Department of Health and Human Services Centers for Disease Control and Prevention (CDC). For additional information I understand that I may call 1-800232-4636 or go to www.dcd.gov/concussioninyouthsports.
GENERAL WAIVER
In consideration of the execution of a similar contract by all persons participating in this program/league, I hereby I agree to abide by all rules, uphold
the principles of sportsmanship and fair play, and abide by the County Code of Conduct. I further agree that the medical information given above is correct. The undersigned do
hereby expressly stipulate and agree to indemnify and hold forever harmless Wicomico County and the Wicomico County Department of Recreation, Parks and Tourism, its
agents, officers and employees, against loss from any and all claims, demands, or actions in law or equity that may hereafter at any time be made or brought by the participant
listed above, or by anyone on behalf of said participant for the purpose of enforcing a claim for damages on account of any injuries received or sustained by the participant arising
out of his participation in the program. In signing this Release and Hold Harmless Agreement, each of the undersigned hereby acknowledges and represents that they are aware of
the risks and hazards inherent in participating in the program including exposure to the potential risk of concussion. No insurance covering accident or injury has been provided
for participants. Arrangements for any such insurance would have to be made individually by the undersigned, and at no time will my participation in a program be contingent on
divulging any confidential medical information.
________________________________________
Participant’s Name
________________________________________________
Parent/Guardian Signature
______________
Date
YOUTH PLAYER CODE OF CONDUCT
I hereby pledge to provide a positive attitude and be responsible for my participation in Youth Sports by following this
Youth Player’s Code of Conduct.
Parents: Please read and explain this to your youth athlete if they are too young to do so themselves.
 I will encourage good sportsmanship from my teammates, coaches, officials, and parents at every game and
practice by demonstrating good sportsmanship.
 I will attend every practice and game that s reasonably possible and will notify my coach if I cannot.
 I will do my best to listen and learn from my coaches.
 I will treat my coaches, other players, officials, and fans with respect regardless of race, sex, creed, or abilities
and I will expect to be treated accordingly.
 I will help my coach is setting up the field and gathering equipment.
 I will help in cleaning the bench are after a game or practice and will make sure no trash is left behind.
 I will always try to do my best!
 I deserve to have fun during my sports experience and will alert my parents or coach if it stops being FUN!
 I deserve to play in an alcohol, tobacco, and drug free environment and expect adults to respect that wish.
 I will encourage my parents to be involved with my team n some capacity because it’s important to me.
 I will remember that sports are an opportunity to learn and have fun.
_________________________________________________
Child’s Name
PARENT CODE OF CONDUCT
I hereby pledge to provide support, care, and encouragement for my child participating in youth recreational sports
by following this Parent’s Code of Conduct
 I will demonstrate positive support and encourage good sportsmanship to all players, officials, and coaches at
every game and practice.
 I will place the physical and emotional well-being of all participants ahead of a personal desire to win.
 I will support a recreational sports environment for my child that is free of drugs, tobacco, and alcohol, and
will refrain from their use at all youth sports events.
 I will recognize that my child’s coach is a volunteer, trained in responsibilities of being a youth sports coach
and deserves my support.
 I will support coaches and officials working with my child by ensuring my child plays by the rules, and is a
team player, encouraging a positive and enjoyable experience for all.
 I will remember that the games are for the children - and not the adults.
 I will do my very best to make youth sports fun for my child.
 I will help my child enjoy the youth sports experience by doing whatever I can, such as being a respectful fan,
assisting with coaching, or providing transportation.
 I will see to it that my child treats other players, coaches, fans and officials with respect regardless of race,
sex, national origin, or ability.
_________________________________________________
Print Name
_________________________________________________
Parent/Guardian Signature
_______________________
Date
PARENTS: Your signature above verifies that you and your youth athlete have read and understand the Code of
Conduct for the Wicomico County Spring Soccer League. Failure to follow the above Code of Conduct could result
in dismal from the program. Wicomico County Recreation & Parks Department and the Wicomico County Soccer
Federation endorse a zero tolerance towards unsportsmanlike behavior exhibited during the program.